Friday, January 9, 2009

Day 7--Triage Tent

This was the first clinic day...

I awoke to the sound of rustling outside the tent. Zipped it open to find a medium sized calf grazing under my laundry line of unmentionables.

You bond rather quickly in a group of people when only tent walls separate you, your toilets are holes dug in the ground, no one has access to a shower, and your underwear hangs from a line. You just can't put on airs or try and out-class someone in these situations.

We had a team meeting where everyone was assigned their posts for the morning.

And a stray dog slept...

There was a certain air of excitement as we marched down the path to the clinic site that first day. Everyone was still pretty shiny and new. Our scrubs still had that 'new hospital smell' to them.

It was a bit slow to start. Our "Himalayan Health" banner hung proudly, the tents were assembled, and we steeled ourselves for the crush of patients that were sure to arrive.

Finally, after 1000h, our first patient arrived and Betsy and I pounced on him, happy to finally get things going.

Then the dam broke.

Dozens of people arrived. After registering with a couple of our translators they began hovering around the entrance to our tiny triage tent. Pushing into the tent, people leaned on each other...peered in, listened in.There was no privacy as we asked, through our interpreters, questions like "when was your last period?" and "does it hurt when you pee?" We were assessing people and directing them to either the gyne tent, the med/surg tent, the peds tent or the ER procedures tent.

Things were always busy in the medicine tent. Always busy.

After being seen, patients were sent to the pharmacy to pick up multivitamins, albendazole if they were 18 or younger, and whatever else we could give them to treat their ills.The pharmacy was inside a government house which we were allowed to use for the clinic.

It certainly provided its own crowd of onlookers.

The first of many adjustments I'd learn to make on this trip was the art of triaging. My background in ER has at times given me the job of triage nurse in major tertiary centers. In that role you have to really have your game face on at all times. Not only do you have to keep track of all the fading flowers in the waiting room, but who is in line, and what is coming in through the ambulance bay. You have to be able to run a quick focused assessment on patients, gather vital signs, take a reasonable history, and stack them in your mind. Do they fall into the "can wait until the next general election" category or do they fall into the "quickened footsteps to the trauma bay while trying to look nonchalant" category? And then how do they rank within those categories....and how are those folks in the waiting room doing, and who is the guy yelling at me about his dad? How am I supposed to know who his dad is anyway?? But I digress...

I quickly realized that triage on this trip was going to be quite different. First I would be deciphering the chief complaint which was written down by the men at the registration table, frequent complaints being "chest pain", "body lumps", and "back pain".

The next step was pronouncing the name to a large mass of people, this feat often met with peals of laughter, the crowd mimicking said pronunciation, then someone being prodded up to the front of the line. After the comedy act of me calling the patient I would be expected to take their temperature, BP, weight (in children), and assertain which tent they belonged in. Then I would walk them to this destination. Rinse. Repeat.

Initially I had been doing what I was used to in Canada, but it soon became apparent that we had to 'move the product' much faster here. I felt like the most useless triage nurse in the history of the world. A quick glance and off they went. Did we even need a triage tent? I had to re-adjust my 'sick look' radar as many people looked sick. Malnutrition and poverty apparent in the children, hard physical labor showing its toll on their parents.

All in all, we saw 75 patients today. Tomorrow we run a second clinic here and the numbers are expected to be much higher.

I have noticed that I felt a bit short of breath today. We are only at 7000ft but in two days will be climbing to over 14 000ft. Tonight I will start diamox. I am sure the SOB is mostly in my head, but I can't help but remember huffing at 12 000ft last year in Switzerland. So I will take it just to be on the safe side. The last thing I want is to be sucking wind at the end of the line because of altitude sickness. I didn't get those blood stained runners this summer to look like a chain smoker at elevation!

Currently Reading

"I cannot rest from travel; I will drink Life to the Lees. All times I have enjoyed Greatly, have suffered greatly, both with those That loved me, and alone; on shore, and when Through scudding drifts the rainy Hyades Vext the dim sea. I am become a name; For always roaming with a hungry heart..." Lord Tennyson